Healthcare Provider Details

I. General information

NPI: 1487049870
Provider Name (Legal Business Name): REBECCA LEIGH MCLEAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 MEDICAL GROUP 1599 JONES STREET
GRAND FORKS AFB ND
58250
US

IV. Provider business mailing address

1599 JONES STREET
GRAND FORKS AFB ND
58250
US

V. Phone/Fax

Practice location:
  • Phone: 701-747-5544
  • Fax:
Mailing address:
  • Phone: 701-747-5544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0057792
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: